10.5005/newborn-2-2-iv
We Need New Tools to Evaluate Neurological Development in Utero and after BirthFetuses, newborns, and young infants are highly susceptible to neurological injury. 1,2 Damage to primordial structures during early development can result in malformations. [3][4][5] Later, injuries can disrupt many of these basic structures in the growth phase. 6,7 Many infectious and non-infectious stimuli can trigger inflammation with its changes, including vasomotor dysregulation with edema and temperature instability, and leukocytosis. 8,9 Our ability to restore damaged neurological structures is still limited, and therefore, the emphasis remains on early detection by cranial imaging and supportive measures. 4,10,11 Similar to diseases affecting other organs, the debate continues about the relative contribution of infectious agents, vasomotor changes, and immaturity of the immune system in the pathogenesis of various neurodevelopmental disorders. 12 Many infectious agents that affect the fetus in utero or during early infancy cannot be treated in a timely fashion. 13 Many drugs still need evaluation, and some that are currently in use have limited efficacy. 14 Others have had unacceptable short-and long-term adverse effects. 15 To appropriately tailor these treatments and minimize risk, accurate neuroimaging is important for early detection of pathogen-induced and other inflammatory changes. 16,17 If we can understand the temporal evolution of these changes, we might be able to make a difference. There is a need for monitoring paradigms and new treatments. All treatment modalities are not uniformly available or affordable in different parts of the world, and hence there is a need for computational systems to assess, monitor, and treat these highly susceptible patients. 18 If we know the possibilities, we can educate and motivate our care providers to acquire and learn these tools. 19 Our journal, the Newborn aims to cover fetal/neonatal problems that begin during pregnancy or occur after birth during the first 1000 days after birth. In this 2 nd issue of the second volume, we present 8 important articles (Figure 1). In an original study, McLean et al. 20 evaluated a cranial ultrasound scoring system for prediction of abnormal early neurodevelopment in preterm infants. In a retrospective, single-center study, they studied cranial ultrasound scans of 242 preterm infants at a chronological age of 6 weeks to compare this scoring system to conventional sonographic detection of abnormalities such as intracranial hemorrhages, white matter lesions, and cystic periventricular leukomalacia. [21][22][23] The aim was to determine whether the scoring system could enhance our accuracy in predicting developmental delay or cerebral palsy (CP) in preterm infants. 24,25 They did not find any differences in sensitivity/specificity 26 when the entire cohort was studied. However, in the subset with severe cranial ultrasound abnormalities, the cUS scores showed higher sensitivity (57% vs. 27%, [95% CI: 12 to 49]) but lower speci...